全科医生小词典——移情

移情(empathy)也翻译成同理心,一种心理咨询和心理治疗上常用的概念和技术,心理治疗师通过转移患者的感情来达到治疗的目的。移情既可以发生在患者身上,也可以让医生所利用。患者的移情现象,是把压抑的潜意识和情绪(喜爱或增根)转向医生,把医生当做发泄对象。另一方面,医生可以利用移情技术,设身处地为患者着想,以医生自己以往的体验来体会患者现在的痛苦和困难,“如果我是他,我会怎么样”,对患者的痛苦表示真诚的理解和关心,从而融洽医患关系,让医生深入地了解患者的躯体和心理问题。再者,医生应该对患者的移情(发泄)做出恰当的反应。没有经验的医生对患者的移情不知所措或回避,而有经验的医生会因势利导,借势促进患者康复。一个重要的“行规”是医生不能让自己陷入患者的移情中,比如患者喜欢医生或医生喜欢患者,即所谓反移情现象。所以全科医学培训理论中认为,全科医生自己首先要接受精神分析,如果医生自己就压抑太重,便不适合给患者提供心理咨询服务。而且医生要经过培训,才能熟练和恰当地使用移情技术,因为这个技术不是天生的,而是习得的。最后提醒注意的是,这里的移情并非当下流行的“移情别恋”,因为这个词主要指的是爱情,而移情可以包括所有人类的情感。...     

医患关系之我见——敬畏生命

医患关系有狭义和广义的两种理解。狭义的医患关系是指医生和患者个体之间的相互关系;广义的医患关系是指以医生为主体的人群与患者为主体的人群之间的关系。医者施医,帮助患者恢复健康;患者求医,接受来自医者的治疗和指导。医患关系这种双向活动,不但决定了双方在医疗活动中的地位和作用,     

移情法在急诊室护理工作中的作用

随着现代医学模式的转变,医学和护理学所关注的不仅仅是病人的疾病,而是从人的生物、心理、社会各方面整体关注病人.本文阐述了移情在急诊室护理工作中的作用,旨在促进急诊科护士正确认识移情,在护理工作中正确运用移情,达到与病人建立良好的护患关系,与医生建立良好的医护关系,提高护理服务质量的目的 .     

以健康教育为切入点,改善高层次医院的医患关系

医患关系是当今社会较为敏感的社会问题,而在日常生活中,人们关注的医患关系是广泛的,是以医生为主体的人群与以患者为主体的人群之间在临床诊疗过程中形成的人际关系,即指医生、护士、医技人员与患者家属及其朋友的关系[1].医患关系的不协调所引发的医疗纠纷已成为社会关注的焦点[2].     

浅谈构建和谐医患关系

医患关系是医务人员与患者在医疗过程中产生的特定医治关系,是医疗过程中最重要的人际关系,现代医患关系是指以医生为主体的人群与以患者为中心的人群的关系。构建和谐医患关系是促进患者满意度提高、提升医院整体形象的重要措施,本文将浅谈构建和谐医患关系的一些看法。     

移情对建立新型医患关系伦理模式的利与弊

在现代社会这样一个转轨时期，医患矛盾越来越突出，如何缓和医患关系、建立新型医患关系伦理模式成为大家共同关心的课题。作者从移情的角度入手，阐述了新型医患关系伦理模式的内涵，分析了移情对于缓和医患关系有哪些有利之处与不利之处，并提出了如何适度利用移情的方法，使其发挥最大作用。     

谈新形势下的医患关系

医患关系是以医疗职业为基础,道德为核心,法律为准绳,并在实践活动中产生与发展的一种人际关系.狭义上是指医疗护理过程中医护人员与患者的特定关系.而广义上是指以医生、护士为主体的人群和以病人为中心的人群在临床诊疗护理过程中建立和形成的人际关系.社会主义市场经济的建立和发展给医患关系带来了新的变化和认识,也带来了一些问题.     

交往分析理论在改善卫生院医患关系中的应用

医患关系是指医生和患者之间的互动,在现代医学伦理的概念中,其是医生与患者之间信赖合作的基础。良好的医患关系是做好医疗卫生服务工作的基础,然而,医患关系紧张成为我国目前医疗卫生服务行业突出现象,已演变为一个复杂的社会问题。尤其在乡镇卫生院,患者对医务人员的技术水平缺乏足够的信任,盲目崇拜大医院的心理较为严重,医患关系紧已成为影响乡镇卫生院服务质量和医务人员身心健康的重要因素之一。在卫生院所发生的医疗纠纷中,仔细分析不难发现:医患沟通不佳往往是导致或加剧医患冲突的核心环节。交往分析理论是一种研究如何改善不同人群的人际交往沟通能力的理     

谈古今医德医患关系

医患关系是古今医学伦理学的主题,现代医患关系的物化和医生权力的绝对化,医生成为医疗实践的主体,患者则被客体化、对象化,他们的关系是相对的,有条件的,医务人员在医疗卫生保健预防活动中,作为一种社会角色,首先要处理的是与患者的关系,医者良好的医德医风,救死扶伤,一切为了病人,能使病人获得安全感、信任感和温暖感,从而使病人早期康复。古代强调“医乃仁术”,当今认为医患关系是关怀与被关怀的关系。总之良好的医德医风、优质的服务能使病人及其家属得到启迪,产生情感上的共鸣,促进两个文明建设。所谓医患关系是以社会主义、人道主义认为原则建立起来的平等关系,是以社会主义法制为保障建立起来的信赖关系,也是以医疗技术为保证的委托关系。尤其是生物心理社会医学模式的建立,还医学以人学的本质。建立了医生和患者的关系,医生是关怀者,患者是被关怀者。把关怀视角引入医患关系不仅是对医生的品质提出了更高的要求,也是对患者提出品质的要求,被关怀者对关怀者的言行要做出积极的反应。     

全科医生小词典——移情

移情（empathy）也翻译成同理心，一种心理咨询和心理治疗上常用的概念和技术，心理治疗师通过转移患者的感情来达到治疗的目的。移情既可以发生在患者身上，也可以让医生所利用。患者的移情现象，是把压抑的潜意识和情绪（喜爱或增根）转向医生，把医生当做发泄对象。另一方面，医生可以利用移情技术，设身处地为患者着想，以医生自己以往的体验来体会患者现在的痛苦和困难，“如果我是他，     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.